A new study published in PLOS Global Public Health examines the financial flows of Indonesia’s COVID-19 vaccination program, revealing significant disparities in resource allocation. The mixed-methods study, which tracked government expenditures in 2021 and 2022, found that while national and regional budgets were the primary funding sources, subnational governments were heavily reliant on central government transfers. This reliance, combined with complex health financing mechanisms and limited local fiscal capacity, resulted in unequal vaccination delivery, particularly in underserved provinces with geographical challenges. The largest expenditures were for cold chain maintenance, distribution, and vaccinator incentives.
The research highlights a critical lesson for future pandemic preparedness: the need for more coordinated and flexible health financing mechanisms, particularly during health emergencies. Disparities in fiscal capacity led to a higher risk of vaccine inequity. The authors emphasize that developing clear resource allocation guidelines and improving the distribution of funds from the national to local levels are essential to ensure equitable outcomes and avoid leaving vulnerable populations behind during health crises.
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